Well over half the Medicare payments made to outpatient rehabilitation facilities over a one-year period were questionable in nature, according to a six-state review released today.
Health and Human Services Inspector General June Gibbs Brown said that of $277 million paid out for outpatient rehab in the six states in the year ending June 30, 1998, $173 million was for "unallowable or highly questionable" services.
Senate Labor-HHS Appropriations Subcommittee ranking member Tom Harkin, D-Iowa, whose office released the report, noted that one facility submitted a claim for payments to a credit card for boating-related expenses and trips to the Caribbean. The six states surveyed-Florida, Louisiana, Michigan, New Jersey, Pennsylvania and Texas-represent nearly half the $572 million that the Health Care Financing Administration, which runs Medicare, paid for outpatient rehab services nationwide in 1997.
The report found that of 192 claims medically reviewed, 66 claims were not reasonable and necessary for the patient's condition and 36 claims were inadequately documented. It said the problem stemmed in part from an inadequate review process for new outpatient rehabilitation facility providers, the failure of HCFA to survey satellite facilities of providers and lack of recertification requirements.
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